The Josiah Macy Jr. Foundation has awarded a two-year, $409,410 grant to the AAFP's Robert Graham Center(www.graham-center.org) and George Washington University, or GWU, both in Washington, to study how well teaching hospitals and teaching health centers are meeting the health care needs of the public.
According to Robert Phillips, M.D., M.S.P.H., director of the Robert Graham Center, the upcoming study will examine two aspects of the medical workforce. They are
- the physician output of all residency training institutions with regard to primary care specialties (family medicine, general internal medicine and pediatrics) and other specialties with shortages (general surgery, geriatrics and psychiatry), as well as to those who choose to practice in medically underserved areas; and
- the career choices and practice sites of residents trained in teaching health centers, which are community-based ambulatory settings that operate a primary care residency program.
When completed, the Graham Center/GWU study will follow the recently released GWU School of Public Health and Health Services study of the "social mission" of U.S. medical schools to produce primary care physicians, encourage them to practice in rural and underserved areas, and recruit and educate minority physicians. Phillips said studying how well graduate medical education, or GME, fulfills this social mission is even more important.
"Teaching hospitals are the real shapers of the physician workforce," Phillips said. "The training they do is also substantially subsidized by Medicare to the tune of $9.5 billion annually. The public deserves some accountability for their product, and several federal agencies are pushing for greater accounting of graduate medical education to better serve the health of the public."
Phillips; Fitzhugh Mullan, M.D., professor of medicine and health policy at the GWU School of Public Health and Health Services and professor of pediatrics at the GWU School of Medicine and Health Sciences; and Stephen Petterson, Ph.D., a senior health analyst at the Robert Graham Center, are the principal investigators for the study.
Phillips said they and additional team members plan to create rankings of teaching hospitals based on measures of how well they are meeting the needs of their surrounding communities.
"This specific accounting will, hopefully, make some (teaching hospitals) question whether they should change their ways, and it may also influence their eligibility for funding or training positions," Phillips said.
In addition to the GME portion of the study, the researchers plan to identify the institutions and programs that are training residents in community health centers and rural health clinics and how this training experience influences physicians to later practice in medically underserved settings.
"We hope to identify more teaching health centers -- both federally qualified and rural health clinics -- that have any residents rotating through between 2000 and 2005, and again in 2009. Then we'll check to see where those trained between 2000 and 2005 wind up: federally qualified health centers, rural health clinics, rural areas and primary care," said Phillips.
"The few studies done so far on teaching health centers did not include all of the rural health clinics, so the simple accounting of training there will be important news," he added.
The researchers will use data from the AMA Physician Masterfile and the National Provider Identifier data file for the GME portion of their study. They will use Medicare claims data to examine teaching health centers.
Phillips said that when the study is completed, researchers will integrate the information into GWU's Medical Education Futures Study website and the Graham Center's HealthLandscape website(www.healthlandscape.org), both of which promote primary care. The researchers also plan to hold a primary care forum to share the study results.